• Joshua M Wiener, Parshva A Sanghvi, Katelyn Vlastaris, Thomas Mroz, Jonathan Belding, David C Kaelber, Thomas Olson, Kevin P Francis, John S Adams, Nicholas Bernthal, and William L Sheppard.
• Case Western Reserve University School of Medicine, Case Western Reserve University, Cleveland, OH.
• Spine. 2025 Feb 3.

Study Designretrospective cohort study.ObjectiveTo investigate the relationship between perioperative Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs) and postoperative outcomes after spinal fusion in obese and diabetic patient populations.Summary Of Background DataGLP-1 RAs have been shown to be beneficial when used perioperatively in clinical orthopaedic arthroplasty literature. Minimal evidence exists showing efficacy with respect to spinal fusion.Materials And MethodsThis retrospective, multi-center study accessed the TriNetX platform, using the research database to identify diabetic patients who underwent spinal fusion between 2008 and 2022. Cohorts were created based on Body-Mass-Index (BMI) and GLP-1 RA usage. Propensity score matching was employed to create balanced cohorts utilizing BMI, Hemoglobin A1c (HbA1c), surgical intervention, as well as other demographic characteristics. Orthopedic outcomes were compared between GLP-1 RA users and non-users. The primary outcomes included post-operative infection, readmission, revision surgery, and quality of life metrics.ResultsAfter matching, the study cohort consisted of 2,263 patients, with 1,560 classified as obese. GLP-1 RA use was associated with significantly reduced post-operative infection rates (obese: HR=0.168 (0.086, 0.328), not obese: HR=0.250 (0.102, 0.612)), fewer revisions (obese: HR=0.505 (0.368, 0.693), not obese: HR=0.439 (0.272, 0.708)), decreased postoperative readmission rates (obese: HR=0.283 (0.243, 0.329), not obese: HR=0.241 (0.193, 0.301)), and reduced mobility abnormalities (obese: HR=0.355 (0.230, 0.549), not obese: HR=0.508 (0.269, 0.959)). No significant differences were observed in rates of fracture rates between GLP-1 RA users and non-users.ConclusionsGLP-1 RA use in spinal fusion patients was associated with improved post-operative outcomes, including lower infection rates, fewer revisions, and better quality of life metrics. These findings suggest that GLP-1 RAs may be a valuable adjunctive therapy in managing surgical outcomes in diabetic and obese patients undergoing spinal fusion. Further prospective and animal-based studies are needed to confirm these findings and explore the underlying mechanisms.Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

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